Current acne treatments were formulated 30-50 years ago, before the 2 major inflection points of human sciences - the Human Genome Project in the early 2000 and the Human Microbiome Project. Therefore, it is safe to state these treatments have not undergone proper analysis of their impact on the human endocrine, genetic and microbiome systems. These treatments predate the new sciences, and predate the latest understandings of the multifactorial causes and links of acne.
Current Acne Prescription Treatments
Antibiotics, Retinoids, Hydrocortisone, Benzoyl peroxide
Globally, the first line of acne treatment today is antibiotics combined with either a hydrocortisone or retinoid. Hydrocortisone is prescribed for its anti-inflammatory effect, but if used for a prolonged period of time, it can even cause more acne. Antibiotics are very controversial because of their misuse which increases bacterial resistance. They further disrupt the microbiome of the gut and the skin. The effectiveness of antibiotics on acne is questionable.
As a topical cream, varying strengths of retinoids (Adapalene, Differin) and benzoyl peroxide (a bleaching agent) are prescribed. These ingredients have a high potential to sensitise the skin, and in the case of benzoyl peroxide, it is a pro-oxidant ingredient (cell damaging).
Hormone Disrupting Chemicals: Isotretinoin, Birth control pills
As a second line of treatment, Isotretinoin (Accutane or Roaccutane) taken orally is a teratogenic treatment that is popularly prescribed. When it first appeared in the early 1980s, it was intended to be prescribed for the most extreme cases of acne. But now it is regularly prescribed. It is a highly controversial treatment. Its printed side effects on the leaflet are serious enough, but some anecdotal stories have linked it to suicidal thoughts, depression and even erectile dysfunction. Other anecdotal evidence shows extreme dry skin and lips, back pain and other debilitating side effects. It is considered one of the most effective prescription treatments for acne. However, about 1/3 of users require a second or third treatment when acne returns.
Contraceptive pills are often prescribed to women and girls as young as 14-15. These pills have been in the market for 60 years, but we still have no clear idea of their long-term effects on women's health. Why? One explanation could be the pill's status as a paragon of female emancipation. And questioning its validity could be seen as anti-feminist. But if the women who use them do not question their safety, the pharmaceutical companies certainly won't.
The pills control acne as a side effect of blocking the ovulation. No ovulation means less androgens are produced. Less androgens means less acne. Anecdotal evidence shows that women who have used birth control pills to control acne have had good success rates on average. However, when they stop taking the pill, acne is likely to return aggressively. In the case of young girls who are still developing their sex organs, we really need to question how these pills affect their normal pubertal development.
Both isotretinoin and contraceptive pills stop or manipulate the normal functioning of our endocrine system. The long term side effects of these treatments have not been made public or are perhaps not even known by the manufacturers. Interestingly, the new sciences are beginning to shine a light on how they impact our gut microbiome and our endocrine system.